Your Passport to Pregnancy
with Egg Donation
Pre-Implantation Genetic Diagnosis
What is PGD?
Pre-Implantation Diagnosis is chosen by prospective parents for a number of different reasons:
1. To test for specific genetic disorders where one of the couple may carry a single gene defect
2. To test embryos for chromosomal disorders, especially where the woman is in her mid to late 30s
3. To choose specific gender for the child for example to avoid certain genetic disorders(also known as gender selection or sex selection)
The technique itself involves removing a single cell from an eight cell embryo (usually a 2 or 3 days after fertilisation) and testing the cell for a range of gender specific disorders. The ultimate aim is to select only healthy embryos for implantation. The technique has been used to try and increase live birth rates in assisted conception, reduce abnormalities and lower spontaneous miscarriage.
Can I select the sex of my baby?
Family Balancing, Gender Selection or Sex Selection have all been terms used to describe non-medically indicated use of preconception gender selection.
The HFEA currently disallows this technique in the U.K. but it is allowed in many other countries including the U.S.A. Cyprus IVF Centre can perform Pre-Implantation Genetic Diagnosis for the purposes of gender selection.
Gender selection is used medically when prospective parents need to avoid certain genetic disorders.UKCFA has been in the news recently on the BBC. Our Consultant Mr Charles Kingsland was interviewed and asked to clarify the legal position of Sex Selection in Northern Cyprus. UKCFA would like to state that PGD for gender selection IS legal in Northern Cyprus. Our sister clinic, Cyprus IVF Centre (CIC) is an ISO accredited unit, which is registered by the State and the Ministry of Health in Northern Cyprus. All procedures carried out in the clinic are legal and subject to inspection by the local authorities.
UKCFA (UK Cypriot Fertility Association) is set up and run by NHS consultants who also run the biggest IVF Centre in the UK (Liverpool). The main purpose of the UKCFA is to assist couples who wish to go abroad for egg donation or IVF treatment. We liaise with the CIC to help identify suitable donors and co-ordinate the treatment cycles of the recipients and the donors. This way the couple’s management in the UK can be carried out under the supervision of NHS consultants and the synchronisation of the donation cycle runs smoothly. The time spent abroad remains minimal.
Couples going abroad for IVF treatment may decide to have gender selection for family balancing. Although family balancing for social reasons remains illegal in the UK, it is legal in Northern Cyprus. UKCFA can assist couples to prepare for an IVF cycle to be carried out with the understanding that if they wish to consider gender selection the couples then need to discuss this directly with the CIC.
How is my treatment managed?
UK Cypriot Fertility Association (UKCFA) and Cyprus IVF Centre (CIC) work closely together to coordinate your treatment. You will have part of your treatment in the UK and part in Cyprus. You will undergo In-Vitro Fertilisation in the same way as other patients who do not require PGD. The Pre-Implantation Diagnosis part of your treatment is performed in the laboratory under strictly controlled conditions.
Your treatment will involve the following stages:
In the UK:
1. Initial Consultation
Just like our other treatments such as Egg Donation, we can see you either at 121 Harley Street in London or in Liverpool or Manchester. You will have an in depth Consultation with either Mr Kingsland or Mr Gazvani discussing your medical history. It is of great benefit if you bring as much information with you, including results of any recent screening tests you have had done. If you decide to proceed with treatment we will arrange a counselling session for you. This is crucial as we feel it is important for our patients to have ample opportunity to demonstrate they have considered all aspects of IVF with PGD.
2. Screening Tests and Medication
Both parters will need to be screened for HIV and Hepatitis as well as blood grouping. The male partner will also need a recent semen sample, which we can perform if this hasn't already been done. Providing the results of the screening tests are acceptable, you will be issued with a prescription and a treatment plan. The medication will be delivered direct to your home and your UK coordinator will tell you exactly what to take and when.
3. Your Medication Regimen
Several steps are required to bring you to a stage where you are ready to fly to Cyprus for Egg Collection. The objective is to produce as many eggs as is safe to ensure you have a good number of eggs to fertilise. In brief the steps are as follows:
a) Down Regulation - This phase switches off your body's natural hormone production and allow your medical team to control your treatment. These may be injections or a nasal spray for a period of about 2 to 4 weeks.
b) Follicular Stimulation - Your medical team will confirm with an ultrasound scan that you are ready to start this phase. This stage involves daily injections of a follicle stimulating hormone (FSH) which encourages the ovaries to produce a good number of eggs for collection and fertilisation in Cyprus. Throughout this phase you will have several ultrasound scans which measure the growth of your follicles. This phase lasts about 10-12 days. On a practical note, towards the end of this phase we will tell you when to schedule your flight to Cyprus.
c) HCG Injection - This is a one off injection which prepares your follicles for egg release. This is a crucial injection and must be taken 36 hours before the scheduled egg collection. As you are flying to Cyprus for the rest of your treatment, the timing of this injection is crucial and we will tell you exactly when to take it.
You now travel to Cyprus. Expect to be there 7-10 days and we can help you plan this.
Your Treatment in Cyprus:
1. Initial Visit
After being collected in Cyprus you will visit the Cyprus IVF Centre to meet your Doctor and Coordinator. They will go through what to expect at your egg collection and give you some more medication to take after your eggs have been collected. This is called Cyclogest or Gestone and helps maintain the lining of your uterus to improve the chances of your embryos implanting.
2. Your Egg Collection and Semen Production
36 hours after your hCG injection you will attend the clinic for egg collection at a time given to you by the team in Cyprus. The procedure lasts about 30-40 minutes and is done either sedation or general anaesthetic. Using a trans vaginal ultrasound, each follicle is drained and passed straight to the embryologist and in the majority of the cases an egg will be present in each follicle. You will need to rest for a while after this procedure in one of our recovery bays.
At the same time as the woman's egg collection, the male partner needs to produce the Sperm Sample which will be used to fertilise the eggs. We recommend 3 days of abstinence before providing the sample.
3. Fertilisation and PGD
The Cyprus IVF Clinic uses the ICSI procedure in all cases to fertilise eggs. Each day you will receive a call explaining how many embryos have fertilised and what their quality is. After about 3 days, or when your embryos are at 8 cell stage, the laboratory can perform Pre-Implantation Genetic Diagnosis (PGD) in accordance with the tests that you have agreed with them, which may include selecting the gender.
4. Embryo Transfer
Using a vaginal speculum, the medical consultant exposes the cervix (neck of the womb), which is then cleaned. The culture medium containing the embryos is loaded in a thin plastic tube called a catheter with a syringe on one end. The doctor carefully guides the catheter through the vagina and cervix, and deposits the embryos into the uterus.
We typically transfer two embryos in accordance with UK regulations. We are aware that multiple pregnancies are associated with an increased risk of miscarriage and
complications during pregnancy. High quality embryos remaining after the transfer can be frozen for use at a later date.
After your embryo transfer you can return home to the UK and continue your normal daily activities, although prolonged strenuous exercise or activity is not recommended. The embryos are quite safe within the uterus and you can walk, bathe, shower and undertake normal daily activities. Sexual intercourse can be resumed whenever you feel like it.
You must continue to take the medication given to you as instructed. After 2 weeks you will perform a pregnancy test.
How Successful is PGD?
So far Cyprus IVF Centre has performed over 400 cases of PGD. Pregnancy rates for under 35 year old women are currently over 50%. In women between 35-39 the pregnancy rate is 37% and women over 40 years old show a current success rate of 18%.Our results.